Theories of Grief
Because grief is the involuntary reaction to bereavement, theories of grief
are those that offer descriptive pictures of how the varied responses may manifest.
Kubler-Ross' (1969) five-stage theory of the dying process (i.e., denial, anger,
bargaining, depression, and acceptance) is one such example. Prior to the work
of Kübler-Ross, Parkes (Bowlby & Parkes, 1970; Parkes, 2001) developed
a description of the phases of grief that extended Bowlby's (1969,1973) attachment
theory. These phases included "(a) numbness, (b) yearning and searching,
(c) disorganization and despair, and (d) reorganization" (Parkes, pp.
29-30).

The many descriptive stage/phase theories of grief that have emerged in the
literature (e.g., Kavanaugh, 1972; Miles, 1984; Sanders, 1999), including those
with up to 10 discrete elements (Westberg, 1971), are potential therapeutic
tools in normalizing the experience of bereaved individuals. However, mental
health counselors must be cautious when applying such theories to clinical
work. The ease with which these theories can be consumed has often led to literalism
in application (Payne, Jarrett, Wiles, & Field, 2002; Worden, 2002). Such
literalism, rather than preventing complications in the experience of grief,
can and often does produce such complications. When misapplied, these descriptive
theories of grief responses can serve to foster a should or must (e.g., Ellis'
2000 REBT) mentality for bereaved individuals such that their concerns about
grieving correctly actually become a Stressor in and of themselves. Both Kübler-Ross
(1969) and Parkes (2001) stated that their identified patterns were descriptive
and only rough guides. In general, (a) there is no reason to believe that there
are a discreet number of responses to the state of bereavement, (b) even if
there were, there is no evidence to suggest that these responses would proceed
in a linear fashion, and (c) such descriptive approaches were / are not intended
to serve as prescriptions for the right or correct manner in which to die or
experience grief (Corr, 1993).

Although there is valuable information to be gleaned from the observed patterns
in grief responses, these patterns should not obscure the remarkable uniqueness
of the experience of grief (e.g., Aiken, 2001; DeSpelder & Strickland,
2002; Fleming & Robinson, 2001; Silverman, 2000). Factors contributing
to the idiosyncratic reactions to bereavement include personality traits, cultural
background, and developmental level of the bereaved as well as the nature of
the relationship with the deceased, mode of death, availability of social support,
and previous and concurrent Stressors (DeSpelder & Strickland; Corr et
al., 2000; Worden, 2002). Because of its emphasis on the individual's phenomenological
experience, a person-centered framework has often been suggested as appropriate
with bereaved clients (Barbato & Irwin, 1992; McLaren, 1998). However,
criticisms of Rogers' (1980) work have been similar to those offered in connection
with a clinical emphasis solely on grief expression, without an accompanying
focus on mourning and coping. More specifically, the person-centered approach
has been criticized for the contention that the therapeutic conditions are
both necessary and sufficient for encouraging awareness and, therefore, growth
(Corey, 2001). In fact, Gilliland and James (1998) argued that the perception
of the lack of technique to move clients beyond the expression and acceptance
of negative emotions is a common criticism of Rogers' approach. In quite parallel
fashion, Rando (1993) has suggested that the expression of grief (i.e., the
involuntary and passive reaction to bereavement) is not sufficient "to
come to successful accommodation of a loss" (p. 219). Encouraging a client
to articulate his or her grief reactions might be beneficial, but is likely
not enough to facilitate movement and coping. Rather, assisting the bereaved
in their expressions of grief is just the beginning of the journey, and clinicians
are charged with the more complex enterprise of guiding clients through the
active process of mourning.

Grief and Mourning
Rando (1993) stressed the need to distinguish between grief and mourning when
issues of treatment are discussed. As noted earlier, grief involves the multiple
responses to the state of bereavement. However, theories that have here been
classified as grief theories contain elements that could be better categorized
as aspects of mourning. For example, consider Kübler-Ross' (1969) stage
of acceptance in which the dying individual has found a sense of peace and
contemplates impending death with calm expectation. Finding a sense of peace
is not merely passive; it implies action by the dying individual. In a similar
vein, Parkes' (1987) last phase is reorganization, that is, bereaved individuals
attempt to put the pieces of their lives back together and find a new way of
living in the world. Reorganization represents a marked shift from the previous
phase of disorganization. Although disorganization is an involuntary experience,
reorganization implies action and is more consistent with mourning, the active
process of coping with bereavement and grief. The point is that, although the
definitions of grief and mourning are rather clearly differentiated, some overlap
exists in some of the theories. Despite this overlap, however, theories of
grief are largely descriptive.

Theories of Mourning - Connections with Counseling
Theory
For mental health counselors unacquainted with the field of thanatology, it
is useful to examine how mourning theories resonate with more traditional counseling
theories. In working with bereaved clients in counseling, the question becomes:
What suggestions for treatment do current theories of mourning provide beyond
a narrow focus on the manifestations of grief? One way to address this question
is to examine how mourning theories can be tied to more traditional counseling
theories. Links between phase / stage approaches to mourning are examined first,
followed by an emphasis on three current mourning theories: Dual Process Model
of Coping with Bereavement (Stroebe & Schut, 1999), Meaning Reconstruction
and the Experience of Loss (Neimeyer, 2001b), and Attachment Theory and Loss:
Revisited (Fraley & Shaver, 1999). In contrast to phase / stage frameworks,
these three latter approaches more fully capture the dynamic and non-linear
process that is mourning. Within each section, primary emphasis is given to
how each mourning theory connects to one primary counseling theory; however,
brief mention is occasionally made to other counseling theories that may resonate
with aspects of each mourning theory. The intention is to offer mental health
counselors direction regarding the usefulness of the mourning theories presented.

Stage / Phase Approaches to Mourning
Two approaches to mourning have used a stage / phase approach and have emerged
from a solely death-loss focus. Worden (1996,2002) developed four tasks of
mourning: to accept the reality of the loss, to work through the pain of grief,
to adjust to an environment in which the deceased is missing, and to emotionally
relocate the deceased and move on with life. As noted by Stroebe and Schut
(2001), Worden's work was an important development in the understanding of
the process of coping adaptively with bereavement as each task is clearly defined
in an action-oriented manner. Rando (1993,1995) similarly identified six "R" processes
of mourning: (a) recognize the loss, (b) react to the separation, (c) recollect
and reexperience the deceased and the relationship, (d) relinquish the old
attachments to the deceased and the old assumptive world, (e) readjust to move
adaptively into the new world without forgetting the old, and (f) reinvest.
Rando operationalized these elements of mourning as processes rather than tasks;
however, like Worden (2002), she suggested that mourners must successfully
complete these elements in order to integrate their loss in a healthy manner.
Although the step-like format of these approaches leaves them susceptible to
the dangers of literalism, both Worden (2002) and Rando (1995) have argued
for a fluid understanding of mourning, one in which these elements can and
do exist simultaneously and are revisited over time.

Stage / Phase approaches to mourning and person-centered counseling. As
noted earlier, a person-centered approach to counseling can, through its focus
on the uniqueness of the human experience, balance the dangers of literalism
in stage / phase type theories. Rogers (1980) consistently emphasized the phenomenological
perspective of each client (Hazier, 2003) and the formative actualizing tendency
of each organism to move toward the realization of his or her full potential
(Raskin & Rogers, 2000). Difficulties arise for individuals when obstacles,
including conditions of worth (e.g., prescriptions for how one must mourn),
are placed in the paths of developing individuals. Such conditions lead to
an external locus of evaluation in which clients are overly concerned with
how others view them; as a result, a disparity emerges between clients' perceived
self-concept and their genuine experience. Bereaved individuals who are exposed
to rigid, "almost dogmatic" (Hagman, 2001, p. 18), conditions of
worth regarding how the mourning process must look may lose touch with their
true individual experience. On the other hand, person-centered counseling can
provide a critical opportunity for bereaved individuals to regain a subjective
sense of their personal responses and actions related to death loss events.
Although theories of grief and mourning can be used to inform the person-centered
mental health counselor's work, his or her primary role is to provide the therapeutic
conditions of empathy, unconditional positive regard, and congruence (Raskin & Rogers).
Clients can then view the conditions of worth imposed by society (e.g., dictates
of how to mourn) more realistically, accept their own responses, and follow
their own subjective valuing process, which leads to positive growth. Therefore,
the person-centered approach is particularly useful in increasing bereaved
individuals' insight and awareness into their grief and mourning experience
(Barbato & Irwin, 1992). Nonetheless, mental health counselors using a
Rogerian approach should be encouraged to direct their therapeutic attention
beyond a sole focus on grief expression to incorporate aspects of the mourning
theories. Person-centered mental health practitioners serve their clients best,
however, when they remain vigilant to the phenomenological core of their theoretical
approach.

Personal
Reflection Exercise #4The preceding section contained information
about theories of grief and mourning. Write
three case study examples regarding how you might use the content of this section
in your practice.

QUESTION
18What are Rando's six "R" processes of mourning? Record the letter of the correct answer
the Answer Booklet.

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